Do alpha-1 receptor blockers prevent severe COVID-19?

Frequent use of alpha-1 receptor blockers neither increases nor reduces the risk of uncomplicated or severe COVID-19 hospitalization in older men with or without benign prostatic hyperplasia (BPH), reveals a recent study.

This observational case-control study was conducted in male Medicare beneficiaries aged 65 years or older, with or without BPH, and treated with alpha-1 receptor blockers or 5-alpha reductase inhibitors.

The investigators estimated the adjusted odds ratios (aOR) and 95 percent confidence intervals (CIs) for outcomes of uncomplicated and severe COVID-19 hospitalization (ie, intensive care unit admission, invasive mechanical ventilation, or death).

A total of 20,963 hospitalized patients with COVID-19 were matched to 101,161 control participants on calendar date and neighbourhood residence.

Primary analysis of males with BPH revealed no difference in the risk of uncomplicated COVID-19 hospitalization (aOR, 1.08, 95 percent CI, 0.996‒1.17) or hospitalization with severe complications (aOR, 0.97, 95 percent CI, 0.88‒1.08). Secondary analysis in men with or without BPH showed corresponding aORs of 1.02 (95 percent CI, 0.96‒1.09) and 0.99 (95 percent CI, 0.91‒1.07).

These findings persisted in subgroup and sensitivity analyses.

Additionally, no significant differences were observed in the risk of severe COVID-19 hospitalization between nonselective and selective alpha-1 blocker use (aOR, 0.98, 95 percent CI, 0.86‒1.10), between higher- and lower-dose alpha-1 blocker use (aOR, 0.96, 95 percent CI, 0.86‒1.08), or between current and remote alpha-1 blocker use (aOR, 1.04, 95 percent CI, 0.91‒1.18).

“Alpha-1 adrenergic receptor antagonists prevent cytokine storm in mouse sepsis models,” the investigators said. “This led to the hypothesis that alpha-1 blockers may prevent severe COVID-19, which is characterized by hypercytokinaemia and progressive respiratory failure.”